West Virginia Schedule AFTC-1                                                                                                     West Virginia  
AFTC-1                                                       Alternative-Fuel Tax Credit                                                                                                           State Tax 
REV. 02/2020                                                         (For periods AFTER January 1, 2015)                                                                                       Department

Taxpayer                                                                                                                  ID
Name                                                                                                                 Number
                                                                                 TAX PERIOD

BEGINNING                                                                                        ENDING
                             MM                    DD                        YYYY                                              MM                                                           DD     YYYY
   ►  Taxpayers desiring to claim the Alternative-Fuel Motor Vehicle Tax Credit must complete Parts A and B of this Schedule.
   ►  Taxpayers desiring to claim the  Quali fied Alternative-Fuel Vehicle Home Refueling Infrastructure Tax Credit must complete Parts A and C of the Schedule.
   ►  Taxpayers desiring to claim the  Quali fied Alternative-Fuel Vehicle Refueling Infrastructure Tax Credit must complete Parts A and D of this Schedule.
   ►  An owner Taxpayer desiring to claim Alternative-Fuel Tax Credit allocated by a Pass-Through Entity subsidiary must complete Parts A and E of this Schedule.

Under penalties of perjury, I declare that I have examined this credit claim form (including accompanying schedules and 
statements) and to the best of my knowledge it is true and complete.

Signature of Taxpayer                                        Name of Taxpayer (type or print)                        Title                                                                     Date

Person to contact concerning this return                                                                             Telephone Number

Signature of Preparer other than Taxpayer                    Address                                                                                                                           Date

Part A       Alternative-Fuel Tax Credit Summary
1. Current year Alternative-Fuel Motor Vehicle Credit from Part B, line 9 (Total if more than one qualifying vehicle). Amounts not 
   supported by Part B will be denied.................................................................................................................................................... 1$
2. Current year Quali fied Alternative-Fuel Vehicle Home Refueling Infrastructure Tax Credit from Part C, line 7. Amounts not 
   supported by Part C will be denied...................................................................................................................................................  2$
3. Current year Quali fied Alternative-Fuel Vehicle Refueling Infrastructure Tax Credit from Part D, line 6 (Total if more than one 
   qualifying refueling infrastructure). Amounts not supported by Part D will be denied........................................................................                           3$
4.  Alternative-Fuel Motor Vehicle Tax Credit and Quali fied Alternative-Fuel Vehicle Refueling Infrastructure Tax Credit Allocated to the
   Owner of a Pass-Through Entity that earned the credit as reported on Part E. Amounts not supported by Part E will be denied.........                                                   4$

5. Unused, unallocated Alternative Fuel Tax Credit from prior years:            2015   $
                                                                                2016   $
An amended tax return (2011 and/or 2012 IT-140, CIT-120, PTE-100 or IT-
140NRC) is required to claim previously unclaimed Alternative Fuel Tax          2017   $
Credits (AFTC). If the unclaimed AFTC is associated with previously             2018   $
un filed 2011 and/or 2012 tax returns, an original return is required for 
the tax years claimed. Any and all supporting documentation must be             2019   $
present or the claim for credit will be denied.
                                                                                2020   $
                                                                                2021   $

                                                                                                                            Total                                                         5$

6. Total Alternative-Fuel Tax Credit Available (add lines 1 through 5)....................................................................................................                6$

Continued on the next page…

Schedule AFTC-1 Page 1 of 4
Rev.02/2020

Taxpayer                                                                                                             ID
   Name                                                                                                         Number
Part A –Continued

7.  Personal Income Tax liability (from line 10 of Form IT-140)...............................................................................................................                7$
8.  Alternative-Fuel Tax Credit for application against Personal Income Tax (Enter the smaller of the amount on line 6 and the 
   amount on line 7 here and on the Tax Credit Recap Schedule.........................................................................................................                        8$

9.  Available Alternative-Fuel Tax Credit after application against Personal Income Tax (subtract line 8 from line 6)............................                                             9$

10. Corporation Net Income Tax liability (from line 16 of Form CIT-120)..............................................................................................                         10 $
11.   Alternative-Fuel Tax Credit for application against the Corporation Net Income Tax (Enter the smaller of the amount on line 9 
   and the amount on line 10 here and on the Tax Credit Recap Schedule [CIT-120TC])................................................................                                           11 $

12.   Available Alternative-Fuel Tax Credit after application against Corporation Net Income Tax (Subtract line 11 from line 9)...........                                                    12 $
13.   Alternative-Fuel Tax Credit to be allocated. If the Taxpayer is a Pass-Through entity and any of the amount on line 12 is to be 
   allocated to the owners of the Pass-Through Entity, complete Part F and enter the total amount of credit to be allocated here...                                                           13 $
14.  Unused, unallocated Alternative-Fuel Tax Credit for carry forward to subsequent years. Subtract the amount on line 13 from 
   the amount on line 12..................................................................................................................................................................... 14 $

                Alternative-Fuel Motor Vehicle Tax Credit 
  Part B        A COPY OF THE BILL OF SALE IS REQUIRED FOR NEW VEHICLE PURCHASES OR ANY INVOICES ASSOCIATED WITH A CONVERSION. 

1. Alternative-Fuel Motor Vehicle (Enter the Vehicle Identi fication Number [VIN]).................................................................................                            1
2. Alternative-Fuel Type (Check predominant Type):
A.       Compressed Natural Gas                B.      Lique fied Natural Gas              C.     Lique fi  ed Petroleum Gas
   ***OPTIONS D, E, F, G, AND H ARE NOT AVAILABLE FOR VEHICLES PURCHASED ON OR AFTER APRIL 15, 2013.***
D.      Hydrogen       E.    Electricity         85% or more by volume fuel mixture:      F.    Methanol        G.    Ethanol                                                                   H.  Other alcohols

3. West Virginia Division of Motor Vehicles Registration Number...........................................................................................................                    3

4. Gross Vehicle Weight (in pounds)......................................................................................................................................................     4                   lbs.
5. New Purchase or conversion:
           A. Date of new purchase:
         **Bill of sale must be attached**                                   Purchase Price*............. 5A $

         or   B. Date of conversion:                                         Actual cost of conversion    5B $
6. Credit factor. If new purchase, enter 0.35 (35%). If conversion of previously registered vehicle, enter .50 (50%)............................                                              60.
7. Potential Credit – Multiply the price (line 5A) or the actual cost of conversion (line 5B) by the value on line 6.................................                                         7$
8.  Maximum Allowable Credit – If the Gross Vehicle Weight (from line 4) is less than 26,000 pounds, enter $7,500. Otherwise, 
   enter $25,000............................................................................................................................................................................  8$
9.  Available Alternative-Fuel Motor Vehicle Credit – Enter the smaller of the value on line 7 (Potential Credit) and the value on line 
   8 (Maximum Allowable Credit). Also, enter this value on Part A, line 1.............................................................................................                        9$
       Payment for the vehicle entered on line 1 has been made after January 1, 2011 and on or before April 14, 2013 (Final payment includes arrangements/acceptance for  fi                                       nancing 
   on/or before April 14, 2013 for vehicle fuel type other than A, B, and C listed above).
       Purchaser of the vehicle has taken possession of the vehicle after January 1, 2011 and on or before April 14, 2013 for vehicle fuel type other than A, B, and C listed above.
       Person claiming the credit on line 9 maintained ownership of the vehicle entered on line 1 through December 31 of purchased year.
                          By checking these boxes and signing the tax return, purchaser certi fies this information to be true.
____________
* Purchase price means the sale price of the vehicle less any amount deducted therefrom for any trade-in allowance 
and/or rebates from the manufacturer or dealer.

Schedule AFTC-1 Page 2 of 4
Rev.02/2020

Taxpayer                                                                                                                                        ID
   Name                                                                                                                     Number

                  Quali fied Alternative-Fuel Vehicle Home Refueling Infrastructure Tax Credit 
Part C
                  (APPLICABLE ONLY FOR INSTALLATIONS MADE PRIOR TO APRIL 15, 2013)

1. Location of Quali fied Alternative-Fuel Vehicle Home Refueling Infrastructure............................................1
2.  Date of installation of Quali fied Alternative-Fuel Vehicle Home Refueling Infrastructure 
   (DOCUMENTATION MUST BE PROVIDED) See instructions on page 4.................................................            2

3. Total Cost of Quali fied Alternative-Fuel Vehicle Home Refueling Infrastructure................................................................................                                    3$

4. Credit Factor – 0.50 (50%)................................................................................................................................................................        4        0.50
5.  Potential Credit – Multiply the actual Total Cost of the Quali fied Alternative-Fuel Vehicle Home Refueling Infrastructure (line 3) 
   by the value on line 4.......................................................................................................................................................................     5$

6. Maximum Allowable Credit – $10,000...............................................................................................................................................                 6$ 10,000
7.  Available Quali fied Alternative-Fuel Vehicle Home Refueling Infrastructure Credit – Enter the smaller of the value on line 5 
   (Potential Credit) and the value on line 6 (Maximum Allowable Credit). Also, enter the value on Part A, line 2..............................                                                      7$

Part D            Quali fied Alternative-Fuel Vehicle Refueling Infrastructure Tax Credit

1.  Location of Quali fied Alternative-Fuel Vehicle Refueling Infrastructure.....................................................................1
2.  Total Cost directly associated with the construction or purchase of the Quali fied Alternative-Fuel Vehicle Refueling 
   Infrastructure................................................................................................................................................................................... 2$
3.  Accessibility – If the Quali fied Alternative-Fuel Vehicle Refueling Infrastructure is generally available for public use enter 1.25, 
   otherwise enter 1.00........................................................................................................................................................................      3 1.___
4.  Credit Factor – For refueling infrastructure placed in service before January 1, 2014, enter 0.625 (62.5%) if the value on line 3 
   is 1.25, otherwise enter 0.50 (50%). For infrastructure placed in service on or after January 1, 2014, enter 0.20 (20%) unless 
   the note below applies.....................................................................................................................................................................       4 0.___
5.  Potential Credit – Multiply the Actual Total Cost of the Quali fied Alternative-Fuel Vehicle Refueling Infrastructure (from line 2) 
   by the value on line 4.......................................................................................................................................................................     5$

6.  Maximum Allowable Credit – Determine this amount by following instructions below.                                                                                                                6$
(a) For tax periods after December 31, 2010 but prior to January 1, 2014 – If line 3 is 1.00, maximum credit is $250,000. If 
   line 3 is 1.25, maximum credit is $312,500.
(b) For tax periods after January 1, 2014 but prior to January 1, 2018 – Maximum credit is 20% of the total costs per facility, 
   up to a maximum of $400,000.
NOTE: When the purchase and installation of quali fied alternative fuel vehicle infrastructure begins prior to January 1, 
2014, but is not completed and placed into service until after January 1, 2014, the taxpayer may choose to fall under the 
rules of either (a) or (b) but not both.
7.  Available Quali fied Alternative-Fuel Vehicle Refueling Infrastructure Credit – Enter the smaller of the value on line 5 (Potential 
   Credit) and the value on line 6 (Maximum Allowable Credit). Also, enter the value on Part A, line 3..............................................                                                 7$

                  Alternative-Fuel Motor Vehicle Tax Credit and Quali fi                                   ed Alternative-Fuel Vehicle Refueling 
Part E
                  Infrastructure Tax Credit Allocated to Owner from Pass-Through Entity

                                                                                 Pass-Through Entity 
    Pass-Through Entity Name                                        Employer Identi fication Number (EIN)                                                                                               Amount of Credit Allocated
                                                                                                                                                                                                       $
                                                                                                                                                                                                       $
                                                                                                                                                                                                       $
                                                                                                                                                                                                       $
                                                                                                                                                                                                       $
                                                                                                                                                                                                       $
                                                                                                                                                                                                       $
Schedule AFTC-1 Page 3 of 4
Rev.02/2020                                                                                                                                       Total                                                $

Taxpayer                                                          ID
Name                                                              Number

Part F     Unused Alternative-Fuel Tax Credit Allocation to Owners

           Owner Name      Owner EIN/SSN Owner %                        Credit Allocated

                                                                    %$

                                                                    %$

                                                                    %$

                                                                    %$

                                                                    %$

                                                                    %$

                                                                    %$

                                                                    %$

                                                                    %$

                                                                    %$

                                                                    %$

                                                                    %$

                                                                    %$

                                                                    %$

                                                                    %$

                                                                    %$

                                                                    %$

                                                                    %$

                           Total Allocated Credit $

Schedule AFTC-1 Page 4 of 4
Rev.02/2020